We are at last seeing a palpable change in the approach to mental health services. Words are beginning to transform into action – a momentum we need to sustain if we are to improve services for some of the most complex patients the NHS serves, says Wendy Lane, Director of Consultancy Services and Transformation at NHS Arden & GEM Commissioning Support Unit.
Mental health is often talked about as a Cinderella service, failing to get the attention it deserves. This has started to change in recent years, most notably with the Five Year Forward View and the supplementary Five Year Forward View for Mental Health. Although we have been talking about ‘parity of esteem’ between mental and physical health for some time, we are now seeing evidence of that talk converting to action, but there is a risk it is happening in silos.
There are pockets of innovative work going on around the country which are making inroads into some of the most challenging mental health conditions. There are still significant barriers to overcome, however, from understanding the true cost and impact of mental health care to developing sustainable solutions for the huge variety of complex conditions which fall within this area.
Understanding the conditions
Mental health is a very broad term covering over 200 disorders from depression and dementia to substance abuse and addiction. Some conditions are neurodevelopmental, and others arise as a result of life trauma or another trigger. Common to all mental health conditions is their ability to impact on all aspects of a patient’s health and wellbeing, to greater or lesser degrees. Understanding the wider impact of mental health conditions is vital when it comes to planning prevention and treatment, and the need to work in partnership with social, community and voluntary care services is undeniable.
Closing the data gap
Mental health is some way behind other conditions when it comes to understanding, tracking and predicting patient behaviour. Work is still needed to unpick how the various services are being used and what impact they are having. This lack of data means getting to the starting line is a challenge in itself. We need to be honest in acknowledging that when it comes to redesigning services, time must be devoted to defining the problem or problems we want to fix and the context in which we are operating.
Developing the right environment to develop patient-centred care
Over a series of projects, we have become very aware of the importance of mutual understanding and support across partners in shaping mental health services. Shared responsibility needs underpinning with appropriate governance so that each organisation feels supported in delivering new solutions. Although attitudes towards and understanding of mental health conditions are improving both within and outside the NHS, there is still work to be done to challenge perceptions of the ‘right care’.
Change with shared learning in mind
The more systematic we are in how we plan, implement and evaluate our work, the easier it becomes to establish how the different elements of change interrelate and which ones are critical to the overall success of a project. This is particularly crucial for programmes which are designed to futureproof the health system.
Mental health remains one of the most complex areas of health care. Demand for services is rising and pressure to provide faster, more patient-focused services is now commanding a much greater level of public and political attention. With the impetus set by the Five Year Forward View for Mental Health, combined with major advances in the way mental health services are commissioned and paid for, the time is right to grasp the nettle and deliver lasting improvements for patients. But in our quest for new solutions, innovators must be mindful of the need to leave a clear path for others to follow.
Arden & GEM has developed and implemented comprehensive service redesign programmes in partnership with commissioners and providers. These have delivered sustainable improvements in key areas, including perinatal mental health, autism, learning disabilities and local care. Read more in our case studies.
